POS0589-HPR NATURE AND SEVERITY OF FUNCTIONAL LIMITATIONS ACCORDING TO THE HEALTH ASSESSMENT QUESTIONNAIRE DISABILITY INDEX IN PATIENTS WITH RHEUMATOID ARTHRITIS AND SEVERE FUNCTIONAL DISABILITY
Authors: M. Van Wissen, M. G. J. Gademan, C. Van den Ende, M. Teuwen, W. Peter, D. Van Schaardenburg, A. Den Broeder, T. P. M. Vliet Vlieland, S. Van Weely
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Despite the availability of effective medical treatment, there is still a subgroup of people with Rheumatoid Arthritis (RA) who have considerable functional limitations due to persistently high disease activity, joint destruction or deformities and/or comorbidities. More insight into the nature and severity of these functional limitations is important to provide adequate treatment matching the needs of this specific subgroup. <h3>Objectives</h3> To describe the nature and severity of functional limitations in patients with RA and severe functional limitations, identified by the Health Assessment Questionnaire Disability Index (HAQ-DI). <h3>Methods</h3> Baseline data from people with RA and severe limitations in physical functioning participating in a randomized controlled trial on the (cost-)effectiveness of longstanding physical therapy as compared to usual care [1] were used. Patients completed the HAQ-DI (Dutch version)[2, 3], a reliable, valid and widely used questionnaire reflecting problems in activities of daily living and consisting of 20 items divided over eight domains (Dressing and grooming, Arising, Eating, Walking, Personal hygiene, Reaching, Gripping and Usual activities). Each item is scored on a 4-point scale ranging from 0 to 3 (no difficulty - unable to perform), with the total HAQ-DI score ranging from 0 to 3 (no disability - severe disability). This preliminary data analysis does not yet take into account the use of assistance/assistive devices. Gender, age, sex and disease duration were recorded, and the EuroQol 5 Dimensions 5 Levels (EQ-5D-5L) administered for health related quality of life (HRQoL) (Single index score (-0.446-1.000), and visual analogue scale (EQ-VAS, 0-100), higher scores indicating better HRQoL). <h3>Results</h3> From 2020-2021, 215 people with RA were included (n=194; 90% women, mean age (standard deviation) of 58.8 (12.9) years and median disease duration (Interquartile Range (IQR)) of 19 (9-27) years (n=166)). The median EQ-5D-5L index and EQ-VAS were 0.6 (0.3-0.7) and 59 (41 -70), respectively. The median total HAQ-DI score was 1.5 (1.1-1.9). The majority (83%, n=179) had a total HAQ-DI score ≥1 indicating moderate to severe activity limitations. The mean HAQ-DI domain scores and the percentage of patients within each domain reporting no/some/much difficulty or inability to perform everyday activities are shown in Figure 1.The median number of domains with a score ≥1 was 8 (range 3-8, IQR 7-8, mean 7.1). More than half of the participants had a domain score ≥1 in all 8 domains (52%, n=111), almost a quarter in 7 domains (24%, n=52), 13% (n=28) in 6 domains and the minority (11%, n=24) in 5 or less domains. The highest proportion of patients with a maximum score of 3 were seen in the domains Personal hygiene (42%) and Reaching (28%), followed by Usual activities and Eating (15% and 14%, respectively). For Gripping, Arising, Walking and Dressing and grooming the proportions of patients with the maximum score was less than 8%. <h3>Conclusion</h3> In a subgroup of patients with RA and severe functional disability, the majority had limitations in almost all the domains of the HAQ-DI. Most severe limitations were seen in Reaching and Personal hygiene and the least severe for Arising and Dressing and grooming. In daily clinical practice, a comprehensive assessment of all areas of daily activities in this subgroup of RA patients is necessary, and because the functional limitations are present and significant in all domains, extensive support from multiple healthcare professionals may be indicated. <h3>References</h3> [1]van Wissen MAT, et al. Physiother Res Int. 2021;e1933. [2]Fries JF, et al. Arthritis Rheum. 1980;23:137-45. [3]Boers M, et al. Ann Rheum Dis. 2007;66:132-3. <h3>Acknowledgements</h3> This project is financially supported by Netherlands Organization for Health Research and Development (ZonMw; 852004018), Ministry of Health, Welfare and Sport (VWS), the Royal Dutch Society for Physical Therapy (KNGF) and the Dutch Arthritis Society (ReumaNederland). <h3>Disclosure of Interests</h3> None Declared.